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Multidirectional instability of the shoulder – current concept

DOI: 10.1186/1758-2555-1-12

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Abstract:

The multidirectional instability of the shoulder is a complex problem in terms of diagnosis and treatment. Distinct from multidirectional hyperlaxity, multidirectional instability has symptoms related with increased translations in more than one direction. Increased translation by the increased capsular ligamentous laxity is underlying pathology of the posterior and multidirectional instability. This increased capsular laxity can be in-borne or developmental and asymptomatic or minimally symptomatic initially. In this stage, attempted translation does not produce symptoms. Jerk and Kim tests reveal posterior clunk without shoulder pain [1,2].However, repetitive subluxation overloads the posteroinferior glenoid labrum by the excessive rim-loading of the humeral head. This excessive rim-loading eventually develops posteroinferior labral lesion varying from simple retroversion to incomplete detachment (Figure 1). In this stage, patient's symptom which is shoulder pain, originates from the labral lesion when the humeral head glides over the pathologic labrum. The compressive force on the torn labrum in the jerk and Kim tests generates shoulder pain. Therefore, intact labrum does not produce shoulder pain no matter how lax the glenohumeral joint is. Increased translation alone produces asymptomatic posterior clunk until the repetitive rim-loading eventually develops posteroinferior labral lesion [3].Four type of the labral lesion have been reported. The Kim lesion is a concealed and incomplete tear of the posteroinferior labrum which is characterized by loss of labral height and retroversion, marginal crack, and loose inside. The lesion is similar to the intratendinous tear of the rotator cuff in that it is not evident in the initial observation. The surgeon should be aware of the lesion and palpate with probe (Figure 2).The retroversion of the glenoid labrum decrease the containment function of the glenohumeral joint which further decrease the shoulder's stability (Figu

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